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Dukhin O, Bala D, Felker E, Golovina P, Tretyakova M, Haes B, Savvinova P. Case report: Combination of veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump in a young male patient with refractory cardiogenic shock due to aluminum phosphide poisoning. Front Cardiovasc Med 2023; 10:1226827. [PMID: 37781306 PMCID: PMC10536139 DOI: 10.3389/fcvm.2023.1226827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/25/2023] [Indexed: 10/03/2023] Open
Abstract
Background Acute toxic myocardial damage may be accompanied by the development of cardiogenic shock (CS), the mortality from which is still unacceptably high. Since there is no specific antidote for many types of toxins, treatment of such patients includes various measures of hemodynamic and respiratory support. The paper presents a case of refractory CS due to possible aluminum phosphide (AP) poisoning. Case summary A 20-year-old man was admitted to the emergency department 4 days after home inhalation of AP due to complaints of nausea, vomiting, abdominal and chest pain. Over the next few hours, he rapidly developed CS, which was refractory to conservative treatment. Therefore, veno-arterial membrane oxygenation (VA-ECMO) was performed, during which hemodynamics stabilized, but later there were signs of left ventricular overload. To unload the left ventricle (LV), an intra-aortic balloon pump (IABP) was implanted, which significantly improved the patient's condition. After 6 days the patient was decannulated, and a few more days later IABP was discontinued. Subsequently, the patient was treated for sepsis due to bilateral pneumonia and acute respiratory distress syndrome and optimal medical therapy for heart failure was prescribed. The patient was discharged after 34th day of hospitalization.
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Affiliation(s)
- Oleg Dukhin
- Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
- Moscow Department of Healthcare, Moscow Clinical City Hospital Named After I.V. Davydovsky, Moscow, Russia
| | - Danila Bala
- Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Evgeny Felker
- Moscow Department of Healthcare, Moscow Clinical City Hospital Named After I.V. Davydovsky, Moscow, Russia
| | - Polina Golovina
- Moscow Department of Healthcare, Moscow Clinical City Hospital Named After I.V. Davydovsky, Moscow, Russia
| | - Mariya Tretyakova
- Moscow Department of Healthcare, Moscow Clinical City Hospital Named After I.V. Davydovsky, Moscow, Russia
| | - Boris Haes
- Moscow Department of Healthcare, Moscow Clinical City Hospital Named After I.V. Davydovsky, Moscow, Russia
| | - Polina Savvinova
- Cardiology Department, Moscow State University of Medicine and Dentistry, Moscow, Russia
- Moscow Department of Healthcare, Moscow Clinical City Hospital Named After I.V. Davydovsky, Moscow, Russia
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2
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Sadeghi M, Zakariaei Z, Rashidian H, Soleymani M. Fatal outcome due to aluminum phosphide poisoning in an old man with a psychiatric disorder as a latent post-COVID-19 challenge: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231177759. [PMID: 37293254 PMCID: PMC10247668 DOI: 10.1177/2050313x231177759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Aluminum phosphide is a metal phosphide widely implemented as a pesticide. In the country of Iran, it is recognized by the colloquial name of rice pill. Any trace of accidental or intentional ingestion of aluminum phosphidecan result in severe hemodynamic disorders and metabolic acidosis, ultimately leading to the patient's mortality. In this report, we document the unfortunate demise of an 85-year-old man who lived in isolation, having lost his wife to COVID-19. The patient consumed aluminum phosphide tablets and, despite resuscitation efforts, inevitably succumbed to the toxic effects.
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Affiliation(s)
- Mahdieh Sadeghi
- Student Research Committee, Mazandaran
University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Toxicology and Forensic Medicine Division,
Mazandaran Registry Center for Opioids Poisoning, Antimicrobial Resistance Research Center,
Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
- Iranian National Registry Center for
Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hale Rashidian
- Departments of Emergency Medicine, Mazandaran
University of Medical Sciences, Sari, Iran
| | - Mostafa Soleymani
- Iranian National Registry Center for
Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
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3
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Elsharkawy RE, Ghonem MM, El-Sarnagawy GN, Nagy AA, Heshmat MM. Cardioprotective role of the coenzyme Q10 and coconut oil in acute aluminum phosphide poisoning: a randomized controlled clinical trial. Toxicol Res (Camb) 2023; 12:507-519. [PMID: 37397927 PMCID: PMC10311162 DOI: 10.1093/toxres/tfad037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 07/04/2023] Open
Abstract
Aluminum phosphide (ALP)-induced cardiotoxicity is a major cause of high mortality rates. As there is no specific antidote, restoring cardiac hemodynamics is the cornerstone for saving patients. Based on oxidative stress theory in acute ALP poisoning, we examined the cardioprotective role of coconut oil and Coenzyme Q10 (COQ10) in ALP poisoning, focusing on their antioxidant capacity. This study was a randomized, controlled, single-blind, phase II clinical trial conducted at Tanta Poison Control Center over 1 year. Eighty-four ALP poisoned patients received supportive treatment and were randomly allocated to three equal groups. Gastric lavage was performed using sodium bicarbonate 8.4% with saline in group I. Alternatively, group II received 50 ml coconut oil, and group III initially received 600 mg CoQ10 dissolved in 50 ml coconut oil; and repeated 12 hours later. In addition to patient characteristics, clinical, laboratory, electrocardiography (ECG), and total antioxidant capacity (TAC) data were recorded and repeated 12 hours later. Patient outcomes were evaluated. There was no significant difference among groups considering patient characteristics, initial cardiotoxicity severity, vital, laboratory data, ECG changes, and TAC. However, 12 hours post-admissions, group III was significantly improved in all clinical, laboratory, and ECG parameters than comparable groups. Significant correlations were observed between elevated TAC in groups II and III with hemodynamic, serum troponin, and ECG variables. Accordingly, the need for intubation, mechanical ventilation, and the total vasopressor dose was significantly decreased in group III compared with other groups. Therefore, coconut oil and COQ10 are promising cardioprotective adjuvant therapy ameliorating the ALP-induced cardiotoxicity.
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Affiliation(s)
- Rasha E Elsharkawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Ayman A Nagy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Mona M Heshmat
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
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4
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Abdelghafar S, Farrag TA, Zanaty A, Alshater H, Darwish A, Hassanien AE. Pattern and predictors of death from aluminum and zinc phosphide poisoning using multi-kernel optimized relevance vector machine. Sci Rep 2023; 13:8268. [PMID: 37217491 DOI: 10.1038/s41598-023-34489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
The use of metal phosphides, particularly aluminum phosphide, poses a significant threat to human safety and results in high mortality rates. This study aimed to determine mortality patterns and predictive factors for acute zinc and aluminum phosphide poisoning cases that were admitted to Menoufia University Poison and Dependence Control Center from 2017 to 2021. Statistical analysis revealed that poisoning was more common among females (59.7%), aged between 10 and 20 years, and from rural regions. Most cases were students, and most poisonings were the result of suicidal intentions (78.6%). A new hybrid model named Bayesian Optimization-Relevance Vector Machine (BO-RVM) was proposed to forecast fatal poisoning. The model achieved an overall accuracy of 97%, with high positive predictive value (PPV) and negative predictive value (NPV) values of 100% and 96%, respectively. The sensitivity was 89.3%, while the specificity was 100%. The F1 score was 94.3%, indicating a good balance between precision and recall. These results suggest that the model performs well in identifying both positive and negative cases. Additionally, the BO-RVM model has a fast and accurate processing time of 379.9595 s, making it a promising tool for various applications. The study underscores the need for public health policies to restrict the availability and use of phosphides in Egypt and adopt effective treatment methods for phosphide-poisoned patients. Clinical suspicion, positive silver nitrate test for phosphine, and analysis of cholinesterase levels are useful in diagnosing metal phosphide poisoning, which can cause various symptoms.
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Affiliation(s)
- Sara Abdelghafar
- Computer Science School, Canadian International College (CIC), Cairo, Egypt
- Scientific Research Group in Egypt (SRGE),
| | - Tamer Ahmed Farrag
- Department of Computer Engineering, MISR Higher Institute for Engineering and Technology, Mansoura, Egypt
| | - Azza Zanaty
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Menoufia University Hospital, Shibin El Kom, Egypt
| | - Heba Alshater
- Forensic Medicine and Clinical Toxicology Department, Menoufia University Hospital, Shibin El Kom, Egypt.
- Scientific Research Group in Egypt (SRGE),, .
| | - Ashraf Darwish
- Faculty of Science, Helwan University, Cairo, Egypt
- Scientific Research Group in Egypt (SRGE),
| | - Aboul Ella Hassanien
- Faculty of Computers and Artificial Intelligence, Cairo University, Cairo, Egypt
- Scientific Research Group in Egypt (SRGE),
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5
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Shi L, Jian T, Tao Y, Li Y, Yu G, Zhao L, Wen Z, Kan B, Jian X. Case Report: Acute Intoxication from Phosphine Inhalation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5021. [PMID: 36981930 PMCID: PMC10048961 DOI: 10.3390/ijerph20065021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/27/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Aluminum phosphide is a highly effective insecticide for fumigation in granaries and is often used in rural grain storage. However, people's awareness of its toxicity is not strong. A case of acute inhalation toxicity of phosphine caused by the use of aluminum phosphide to fumigate a granary is reported here. The case presented with aspiration pneumonia and acute left heart failure. The patient was cured using comprehensive life support treatment, including respiratory support, antiarrhythmic treatment, and blood pressure maintenance with vasoactive drugs. There is no specific antidote for phosphine poisoning at present, and the comprehensive application of restricted fluid resuscitation, high-dose glucocorticoid shock, vasoactive drugs and bedside hemofiltration is significant in improving the prognosis of patients. It is also important to remind people to pay attention to their own protection in the process of using aluminum phosphide.
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Affiliation(s)
- Longke Shi
- School of Public Health, Shandong University, Jinan 250012, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Tianzi Jian
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yiming Tao
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yaqian Li
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Guangcai Yu
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Liwen Zhao
- School of Public Health, Shandong University, Jinan 250012, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Zixin Wen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Baotian Kan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- Department of Geriatric Medicine, Department of Nursing, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Xiangdong Jian
- School of Public Health, Shandong University, Jinan 250012, China
- Department of Poisoning and Occupational Diseases, Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
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6
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Mittal N, Elmassry M, Abohelwa M. Refractory cardiogenic shock caused by zinc phosphide toxicity. Proc AMIA Symp 2023; 36:224-225. [PMID: 36876253 PMCID: PMC9980473 DOI: 10.1080/08998280.2022.2136920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Zinc phosphide toxicity is a rare entity that presents most frequently among farmers in developing countries who use it as a rodenticide. The phosphine gas released after the ingestion inhibits cytochrome c oxidase, disrupting the mitochondrial physiology and oxidative phosphorylation and causing myocardial stunning. Here we present a case of a 20-year-old man who attempted suicide with zinc phosphide toxicity. Initially, he was hemodynamically stable with a normal ejection fraction; however, in a few hours, he deteriorated quickly and became hemodynamically unstable, with rapid deterioration of his ejection fraction to 20%. He was started on norepinephrine and then dobutamine; however, he had cardiac arrest from refractory cardiogenic shock despite resuscitative measures.
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Affiliation(s)
- Nitish Mittal
- Department of Internal Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Mohamed Elmassry
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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7
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Khodavysi M, Kheiripour N, Ghasemi H, Soleimani-Asl S, Jouzdani AF, Sabahi M, Ganji Z, Azizi Z, Ranjbar A. How can nanomicelle-curcumin modulate aluminum phosphide-induced neurotoxicity?: Role of SIRT1/FOXO3 signaling pathway. AIMS Neurosci 2023; 10:56-74. [PMID: 37077959 PMCID: PMC10106336 DOI: 10.3934/neuroscience.2023005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
Aluminum phosphide (ALP) is among the most significant causes of brain toxicity and death in many countries. Curcumin (CUR), a major turmeric component, is a potent protective agent against many diseases, including brain toxicity. This study aimed to examine the probable protection potential of nanomicelle curcumin (nanomicelle-CUR) and its underlying mechanism in a rat model of ALP-induced brain toxicity. A total of 36 Wistar rats were randomly divided into six groups (n = 6) and exposed to ALP (2 mg/kg/day, orally) + CUR or nanomicelle-CUR (100 mg/kg/day, orally) for 7 days. Then, they were anesthetized, and brain tissue samples were dissected to evaluate histopathological alterations, oxidative stress biomarkers, gene expression of SIRT1, FOXO1a, FOXO3a, CAT and GPX in brain tissue via hematoxylin and eosin (H&E) staining, biochemical and enzyme-linked immunosorbent assay (ELISA) methods and Real-Time PCR analysis. CUR and nanomicelle-CUR caused significant improvement in ALP-induced brain damage by reducing the MDA levels and induction of antioxidant capacity (TTG, TAC and SOD levels) and antioxidant enzymes (CAT, GPX), modulation of histopathological changes and up-regulation of gene expression of SIRT1 in brain tissue. It was concluded that nanomicelle-CUR treatment ameliorated the harmful effects of ALP-induced brain toxicity by reducing oxidative stress. Therefore, it could be considered a suitable therapeutic choice for ALP poisoning.
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Affiliation(s)
- Milad Khodavysi
- Department of Pharmacology and Toxicology, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nejat Kheiripour
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Hassan Ghasemi
- Department of Clinical Biochemistry, Abadan University of Medical Sciences, Abadan, Iran
| | - Sara Soleimani-Asl
- Department of Anatomical Sciences, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Fathi Jouzdani
- Neuroscience and Artificial Intelligence Research Group (NAIRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- USERN office, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammadmahdi Sabahi
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zahra Ganji
- USERN office, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Azizi
- Neuroscience and Artificial Intelligence Research Group (NAIRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
- USERN office, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Department of Pharmacology and Toxicology, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- * Correspondence: E-mail: ; Tel: +988138381590
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8
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Helal NE, Lashin HI, Nagy AA, Shama MA, Mostafa TAH, Wahdan AA. Potential role of paraffin oil gastric lavage in acute aluminum phosphide poisoning: a randomized controlled trial. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:33844-33855. [PMID: 35031985 DOI: 10.1007/s11356-021-17778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
Aluminum phosphide (ALP) poisoning is a true medical emergency associated with high mortality. The lack of a specific antidote for ALP poisoning mandates searching for new treatment modalities. This study aimed to evaluate the effectiveness and safety of gastric decontamination by paraffin oil in cases with acute ALP poisoning. This study was a randomized, controlled, parallel-group, single-blind, phase II clinical trial conducted over a period of 6 months. Sixty-two patients with acute ALP poisoning were randomly allocated into two equivalent groups. In both groups, the standard ALP treatment was given. Gastric decontamination in the control group was performed by saline and sodium bicarbonate 8.4%, while in the intervention group, it was done by paraffin oil and sodium bicarbonate 8.4%. All patients were subjected to history taking, clinical examination, and laboratory investigations. The outcomes were evaluated. The median age of the studied patients was 20 years. Most of the studied cases were females, single, and from rural areas. The median delay time was 1 h. All patients included in the study alleged ingestion of ALP during suicidal attempts. Twelve hours after admission, many clinical and laboratory findings were significantly better in the intervention group. The need for intubation, mechanical ventilation, and total amount of vasopressors was significantly lower, and the mortality rate was non-significantly lower in the intervention group compared to the control. The median length of hospital stay was significantly shorter in the control group. Gastric decontamination with paraffin oil and sodium bicarbonate 8.4% could be valuable in reducing ALP poisoning severity, the need for intubation, mechanical ventilation, and vasopressors.
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Affiliation(s)
- Nadia E Helal
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt
| | - Heba I Lashin
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt
| | - Ayman A Nagy
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt
| | - Mohamed A Shama
- Department of Emergency Medicine and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Tarek Abdel Hay Mostafa
- Department of Anaesthesiology and Critical Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amira A Wahdan
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Tanta University, Medical Campus, El-Gash Street, Tanta, El-Gharbia Governorate, Egypt.
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9
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Naddafi M, Mehrizi AA, Eghbal MA, Khansari MG, Azarmi Y, Sattari MR, Karaman C, Karimi F, Alizadeh M, Yazdani MN, Hosseinpour P. Reducing the risk of death induced by aluminum phosphide poisoning: The new therapies. CHEMOSPHERE 2022; 294:133800. [PMID: 35101429 DOI: 10.1016/j.chemosphere.2022.133800] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/22/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Numerous people suffer from accidental or deliberate exposure to different pesticides when poisoning with aluminum phosphate (AlP) is increasing in the eastern countries. Aluminum phosphate is a conventional insecticide that quickly reacts with water or the moistures in the atmosphere and produces fatal phosphine gas, which absorbs quickly by the body. Oral consumption or inhalation of AlP leads to excessive reaction of the body such as fatigue, vomiting, fever, palpitation, vasodilatory shock, increasing blood pressure, cardiac dysfunction, pulmonary congestion, shortness of breath, and death. The garlic smell from the patient's mouth or exhale is one of the methods to recognize the positioning. Due to the lack of individual antidotes, several supportive treatments are required. The present study focused on the available and new therapies that help reduce the effect of AlP poisoning and the mortality rate. The therapies are divided into the antioxidant-related agent and the other agents. The impacts of each agent on the experimental cases are reported.
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Affiliation(s)
- Mastoureh Naddafi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbasali Abouei Mehrizi
- School of Physics, University of Electronic Science and Technology of China, Chengdu, 610054, China.
| | - Mohammad Ali Eghbal
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Ghazi Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Yadollah Azarmi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Sattari
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ceren Karaman
- Akdeniz University, Department of Electricity and Energy, Antalya, 07070, Turkey.
| | - Fatemeh Karimi
- Department of Chemical Engineering, Quchan University of Technology, Quchan, 9477177870, Iran
| | - Marzieh Alizadeh
- Pharmeceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Laboratory of Basic Sciences, Mohammad Rasul Allah Research Tower, Shiraz University of Medical Sciences, Shiraz, PO Box: 71348-14336, Iran
| | - Mohammad Nima Yazdani
- Laboratory of Basic Sciences, Mohammad Rasul Allah Research Tower, Shiraz University of Medical Sciences, Shiraz, PO Box: 71348-14336, Iran
| | - Parsa Hosseinpour
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran
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10
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Özkale M, Özkale Y, Kozanoglu İ. Role of automated red blood cell exchange in the treatment of aluminum phosphide poisoning: A case report and review of the literature. J Clin Apher 2022; 37:320-325. [PMID: 35104018 DOI: 10.1002/jca.21966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
Aluminum phosphide (AIP) is a fumigant commonly used in agricultural areas. AIP is frequently misused for suicidal purposes because it is easily accessible. AIP poisoning causes severe metabolic acidosis, resistant hypotension, acute respiratory distress syndrome, and multiorgan failure with cardiogenic shock. Despite supportive management and intensive care, most patients die following AIP ingestion because there is no specific antidote. In this case report we present a 15-year-old female who presented with vomiting, coma and epigastric pain. She developed resistant metabolic acidosis and hypotension due to AIP poisoning. Although supportive treatment did not result in clinical improvement, she was successfully treated with automated red blood cell exchange. Automated red blood cell exchange is a procedure which is used to exchange the patient erythrocyte mass with donor red blood cell. Although automated red blood cell exchange is a preferred treatment method in the complications of sickle cell anemia, some blood diseases and infectious diseases such as malaria and babesiosis, there is little information about its use in poisoning. To the best of our knowledge, this is the first child with AIP poisoning who was treated with automated red blood cell exchange.
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Affiliation(s)
- Murat Özkale
- Baskent University Faculty of Medicine, Division of Pediatric Intensive Care, Dr Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - Yasemin Özkale
- Baskent University Faculty of Medicine, Division of Pediatrics, Dr Turgut Noyan Teaching and Medical Research Center, Adana, Turkey
| | - İlknur Kozanoglu
- Baskent University Faculty of Medicine, Division of Physiology, Dr Turgut Noyan Teaching and Medical Research Center, Adult Bone Marrow Transplantation Center, Adana, Turkey
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11
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Elgazzar FM, Shama MA, Shoeib O, Hafez ASAF. The Role of Echocardiographic Findings in Estimating Survival Probability of Intensive Care Unit Admitted Aluminum Phosphide Poisoned Patients. J Med Toxicol 2022; 18:128-138. [PMID: 35083735 PMCID: PMC8938530 DOI: 10.1007/s13181-021-00868-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiotoxicity represents the primary cause of death in acute aluminum phosphide (AlP) poisoning. Prompt supportive care can improve patient survival. This study assessed the role of echocardiography in estimating the survival probability of AlP-poisoned patients admitted to the intensive care unit. METHODS A prospective cohort study of symptomatic acute AlP poisoned patients was conducted between September 2019 and December 2020. Patients were subjected to history taking, clinical examination, To be included, patient evaluation needed to include electrocardiographic (ECG) and echocardiographic studies. The statistical analysis assessed the association between patient survival and relevant factors. Survival analysis was performed using the Kaplan-Meier survival curve and Cox proportional hazard regression. RESULTS A total of 90 patients met inclusion criteria. Electrocardiographic abnormalities were detected in 38.1% of survivors and 82.6% of non-survivors (p < 0.001). Survivors had a higher mean left ventricle ejection fraction (LVEF) (50.86 ± 6.30% vs. 26.52 ± 7.64%, respectively, p < 0.001) and a lower percentage of global LV hypokinesia (4.8% vs. 94.2%, p < 0.001). The mean survival time was higher among patients with LVEF ≥ 50% than those with LVEF = 41-49% and ≤ 40% (p = 0.014 and 0.001, respectively). The hazard of death was 4.42 and 5.40 times greater in patients with LVEF ≤ 40% or with global LV hypokinesia, respectively. Regression revealed that the global LV hypokinesia, ECG abnormalities, and decreased LVEF and oxygen saturation were significantly associated with the risk of death (hazard ratios: 4.382, 3.348, 0.957, and 0.971, respectively). CONCLUSIONS Echocardiography represents a valuable diagnostic tool to assess cardiac function in acute AlP poisoning. Both LVEF and global LV hypokinesia significantly impact the survival of AlP-poisoned patients. Echocardiography was superior to ECG changes in terms of accuracy for the prediction of mortality.
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Affiliation(s)
- Fatma M. Elgazzar
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Medical Collages Complex, Tanta University, Al-Geesh Street, Tanta, 31527 Egypt
| | - Mohamed A. Shama
- Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Osama Shoeib
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amal S. A. F. Hafez
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Medical Collages Complex, Tanta University, Al-Geesh Street, Tanta, 31527 Egypt
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12
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Malve H, More D, Wankhede M. Management of aluminium phosphide poisoning with a holistic approach at NHL municipal medical college and hospital, Ahmedabad. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Naddafi M, Eghbal MA, Ghazi Khansari M, Sattari MR, Azarmi Y, Samadi M, Mehrizi AA. Sensing of oxidative stress biomarkers: The cardioprotective effect of taurine & grape seed extract against the poisoning induced by an agricultural pesticide aluminum phosphide. CHEMOSPHERE 2022; 287:132245. [PMID: 34543908 DOI: 10.1016/j.chemosphere.2021.132245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/24/2021] [Accepted: 09/11/2021] [Indexed: 06/13/2023]
Abstract
Aluminum phosphide is a well-known hazardous agent used as an agricultural pesticide to protect stored grains from insect damage. However, accidental consumption of a trivial amount of it caused irreversible damage to the human body or even death in acute cases. The present study used taurine and grape seed extract as a natural cardioprotective medicine against aluminum phosphide poisoning by decreasing oxidative stress. The activity of oxidative stress biomarkers (Malondialdehyde, Catalase, Protein carbonyl, and Superoxide dismutase) were evaluated in the cell line model on Human Cardiac Myocyte cells. In the beginning, to clarify the pure impact of aluminum phosphide poison, taurine, and grape seed extract on the human heart cells, their effects on the biomarkers quantity in cell line were measured. Subsequently, the effect of taurine and grape seed extract with various concentrations as a treatment on the oxidative stress biomarkers of the poisoned heart cells were studied. Data analysis reveals that taurine and grape seed extract treatment can successfully diminish the poisoning effect by their antioxidant properties. The oxidative markers values of the poisoned cells were recovered by taurine and grape seed extracts treatment. Taurine (2 g/l) can recover Malondialdehyde, Catalase, Protein carbonyl, and Superoxide dismutase by 56%, 78%, 88%, 78%, when the recovering power of grape seed extract (100 g/l) for the aforementioned enzymes are 56%, 0.71%,74%, 51%, respectively. Therefore, it is clear that the performance of taurine in the recovery of the biomarkers' value is better than grape seed extract.
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Affiliation(s)
- Mastoureh Naddafi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ali Eghbal
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mahmoud Ghazi Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Sattari
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yadollah Azarmi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahedeh Samadi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbasali Abouei Mehrizi
- School of Physics, University of Electronic Science and Technology of China, Chengdu, 610054, China
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14
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Mahlooji MA, Heshmati A, Kheiripour N, Ghasemi H, Asl SS, Solgi G, Ranjbar A, Hosseini A. Evaluation of Protective Effects of Curcumin and Nanocurcumin on Aluminium Phosphide‑Induced Subacute Lung Injury in Rats: Modulation of Oxidative Stress through SIRT1/FOXO3 Signalling Pathway. Drug Res (Stuttg) 2021; 72:100-108. [PMID: 34614532 DOI: 10.1055/a-1647-2418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Aluminum phosphide (AlP) is widely used to protect stored food products and grains from pests and rodents. The availability of AlP, especially in Asian countries it has become a desirable factor to commit suicide. The phosphine produced from ALP is a very reactive radical and a respiratory inhibitor that causes oxidative damage. There is no dedicated antidote or effective drug to manage AlP-induced lung toxicity. The present study aims to evaluate and compare the protective effects of curcumin and nanocurcumin on ALP‑induced subacute lung injury and determine the underlying mechanism. METHODS Rats were exposed to AlP (2 mg/kg/day, orally)+curcumin or nanocurcumin (100 mg/kg/day, orally) for 7 days. Then rats were anesthetized and lung tissues were collected. Oxidative stress biomarkers, genes expression of antioxidant enzymes, participated genes in the SIRT1/FOXO3 pathway, and lung histopathology were assessed by biochemical and ELISA methods, Real-Time PCR analysis, and H&E staining. RESULTS Curcumin and nanocurcumin produced a remarkable improvement in AlP-induced lung damage through reduction of MDA, induction of antioxidant capacity (TAC, TTG) and antioxidant enzymes (CAT, GPx), modulation of histopathological changes, and up-regulation of genes expression of SIRT1, FOXO3, FOXO1 in lung tissue. CONCLUSION Nanocurcumin had a significantly more protective effect than curcumin to prevent AlP-induced lung injury via inhibition of oxidative stress. Nanocurcumin could be considered a suitable therapeutic choice for AlP poisoning.
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Affiliation(s)
- Mohammad Ali Mahlooji
- Department of Pharmacology and Toxicology, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ali Heshmati
- Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nejat Kheiripour
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Hassan Ghasemi
- Department of Clinical Biochemistry, Abadan University of Medical Sciences, Abadan, Iran
| | - Sara Soleimani Asl
- Department of Anatomical Sciences, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghasem Solgi
- Department of Immunology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Department of Pharmacology and Toxicology, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Asieh Hosseini
- Razi Drug Research Center, Iran University of Medical Sciences, Tehran, Iran
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15
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Katwal S, Malbul K, Mandal SK, KC S, Alam MZ, Karki P, Pant C. Successfully managed aluminum phosphide poisoning: A case report. Ann Med Surg (Lond) 2021; 70:102868. [PMID: 34603718 PMCID: PMC8463823 DOI: 10.1016/j.amsu.2021.102868] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION and Importance: Aluminum phosphide (ALP) is a commonly available pesticide in agricultural countries like Nepal. Upon ingestion, this releases highly toxic phosphine gas in the gastrointestinal tract when it comes in contact with humidity. This leads to refractory shock, metabolic acidosis, cardiac arrhythmia, renal failure, and hepato-biliary impairment. CASE PRESENTATION We present a successfully managed case of a 17-year-old girl who ingested 6 g (2 tablets) of ALP tablets with suicidal intent. Although the mortality has been reported as 70-100% with mere ingestion of 150-500 mg of ALP, this case survived even after developing severe metabolic acidosis, acute renal failure, refractory shock, and ventricular tachycardia. CLINICAL DISCUSSION ALP poisoning is most often lethal. However, there is an emerging evidence of successful use of various drugs such as magnesium sulfate, trimetazidine, and other interventions such as intra-aortic balloon pump and extra corporeal membrane oxygenation in case of ALP poisoning. CONCLUSION Owing to the unavailability of an effective antidote of ALP to date, we emphasize early initiation of supportive management, intensive monitoring, and potential role of membrane stabilizers like magnesium sulfate, and cardio-protective agents like trimetazidine, N-Acetyl cysteine, thiamine, vitamin C, and hydrocortisone in decreasing the likelihood of fatal outcome.
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Affiliation(s)
| | - Kiran Malbul
- Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | | | - Soniya KC
- Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Md Zafar Alam
- Department of Medicine, Resident of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Parag Karki
- Department of Medicine, Faculty of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Chiranjibi Pant
- Department of Medicine, Faculty of Internal Medicine, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
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16
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Bogale DE, Ejigu BD, Muche TA. Clinical Profile and Treatment Outcome of Aluminum Phosphide Poisoning in Felege Hiwot Referral Hospital, Northwest Ethiopia: A Retrospective Study. Open Access Emerg Med 2021; 13:239-248. [PMID: 34163261 PMCID: PMC8216064 DOI: 10.2147/oaem.s313181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Aluminum phosphide (AlP) is an effective fumigant and rodenticide which is a commonly used agent for self-poisoning in parts of Ethiopia. AlP poisoning results in serious manifestations involving many vital organs and it has high mortality. Despite its high incidence and mortality, studies on AlP poisoning in Ethiopia are lacking. Our objective was to study the clinical profile and treatment outcome of AlP poisoning in Felege Hiwot Referral Hospital (FHRH), a major referral hospital in Ethiopia. Methods It is a retrospective study conducted over all consecutive AlP poisoning cases who presented to the emergency department (ED) of the hospital from March 2018 to August 2020. A questionnaire was used to collect data from patient medical records. All data were analyzed using SPSS 25. Results A total of 125 patients were studied. Females were 57.6% and males were 42.4%. Age of patients ranged from 12 to 60 with mean age 28.5 years. The average number of AlP tablets taken was 1.2 (3.6 gm) and the average time of arrival to hospital after AlP ingestion was 4.8 hours. Nausea and vomiting were the commonest presenting features seen in 74.4% of the cases followed by hypotension which was seen in half of the cases. A wide range of laboratory findings and complications were also observed. Cases of AlP poisoning with hypotension were managed in the ICU with dopamine infusion, magnesium sulphate, hydrocortisone, and calcium gluconate in addition to gastric lavage and fluid administration. Those cases without hypotension were managed with gastric lavage and maintenance fluid only. Overall mortality from AlP poisoning was 31.2%. Conclusion With a treatment protocol used in FHRH, mortality from AlP poisoning was 31.2%. Using this protocol in resource limited settings might give opportunities to reduce mortality from AlP poisoning.
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17
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Yadav D, Bhattacharyya R, Banerjee D. Acute aluminum phosphide poisoning: The menace of phosphine exposure. Clin Chim Acta 2021; 520:34-42. [PMID: 34077754 DOI: 10.1016/j.cca.2021.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 01/29/2023]
Abstract
Aluminum phosphide (AlP) is a popular fumigant used widely for the safe storage of food grain. Although A1P is free from toxic residues, it releases phosphine which acts on mitochondrial components of almost all types of pests. Unfortunately A1P is also a common suicidal agent in developing countries with no known antidote. In addition, accidental exposure to phosphine may also occur. AlP poisoning affects cardiac and vascular tissue directly and can result in multiorgan system failure leading to death in severe cases. There is no specific biomarker for diagnosing AlP poisoning and management depends on a high level of clinical suspicion. Although acetylcholinesterase has been suggested as a surrogate biomarker of AlP exposure, there are opposing views. In this review, we analyzed the relevant published material with emphasis on the need to recognize and explore the use of plasma mitochondrial enzyme activity as a potential biomarker for AlP exposure.
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Affiliation(s)
- Deepak Yadav
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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18
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Hadeiy SK, Parhizgar P, Hassanian-Moghaddam H, Zamani N, Khoshkar A, Kolahi AA, Amirabadizadeh A, Rezaei O. Trends of acute drug and chemical toxicities in adults and adolescents in Tehran, Iran between 2012 and 2018: a retrospective chart review. Drug Chem Toxicol 2021; 45:2039-2048. [PMID: 33858280 DOI: 10.1080/01480545.2021.1903486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Poisoning is among the top three common causes of suicidal deaths in Iran. We aimed to evaluate the epidemiologic trend of poisoning and its mortality rate in the largest tertiary toxicology referral center in Iran between 2012 and 2018. A total of 84,242 patients were hospitalized or died due to poisoning in this center during the study period, of whom 2114 (2.5%) died. The most frequent poisonings were those with antiepileptics, sedativehypnotics, and antiparkinson medications (T42) followed by narcotics and psychodysleptics (T40). Psychodysleptics had the highest mortality rate (684; 32.4% of the deaths). Among drugs of abuse, methadone was the most common cause of admission reported in 10,398 cases (12.3%). In conclusion, suicidal or recreational methadone poisoning is becoming the most common cause of admission to poisoning referral wards in Iran. Rigorous supervision of daily dosing at opioid maintenance clinics as well as efforts to control the black-market offering methadone are needed to prevent further methadone-related acute poisonings and deaths.
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Affiliation(s)
- Seyed Kaveh Hadeiy
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parinaz Parhizgar
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Hassanian-Moghaddam
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Khoshkar
- Department of Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Omidvar Rezaei
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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Valipour R, Shekari A, Setareh M, Soltaninejad K. Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths: A Retrospective 7-Year Forensic-Based Study in Iran. Am J Forensic Med Pathol 2021; 42:23-29. [PMID: 32868498 DOI: 10.1097/paf.0000000000000607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.
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Affiliation(s)
| | | | | | - Kambiz Soltaninejad
- Department of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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20
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Shakur AM, Garba NA, Ahmadu I, Apollos D, Asani MO, Aliyu I. Accidental poisoning with aluminum phosphide presenting with excessive cholinergic symptoms with response to atropine: A case report. Avicenna J Med 2021; 11:58-61. [PMID: 33520793 PMCID: PMC7839258 DOI: 10.4103/ajm.ajm_156_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Accidental poisoning in children, though underreported in our environment, is common and could prove fatal. It is important to identify the primary chemical agent that is responsible for the poisoning. We present a case of accidental ingestion of fish poisoned with aluminum phosphide (AlP) used as rat poisoning by a 14-month-old girl. At presentation, the actual chemical content of the poison was not available and clinical features were suggestive of organophosphate poisoning. She was commenced on atropine together with other treatment, on which she made remarkable improvement. The atropine was continued with complete resolution of symptoms on the third day of admission. We, therefore, report a serendipitous use of atropine in the management of AlP poisoning with successful outcome.
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Affiliation(s)
- Abubakar Muhammad Shakur
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Nuhu Abubakar Garba
- Department of Paediatrics, Federal Medical Centre, Nguru, Yobe State, Nigeria
| | - Ibrahim Ahmadu
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Daniel Apollos
- Department of Paediatrics, Federal Teaching Hospital, Gombe, Gombe State, Nigeria
| | - Mustafa O Asani
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
| | - Ibrahim Aliyu
- Department of Paediatrics, Cardiopulmonary Unit, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria
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21
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Naddafi M, Eghbal MA, Ghazi-Khansari M, Sattari MR, Azarmi Y. Study of the cardioprotective effects of crocin on Human Cardiac Myocyte cells and reduction of oxidative stress produced by aluminum phosphide poisoning. J Pharm Pharmacol 2021; 73:1539-1546. [PMID: 33793778 DOI: 10.1093/jpp/rgaa066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The effects of Crocin as a cardioprotective material against Aluminum phosphide poisoning by reducing the oxidative stress is investigated. METHODS The level of biomarkers of oxidative stress (Catalase, Superoxide dismutase, Malondialdehyde and Protein carbonyl) were measured in the cell culture model on Human Cardiac Myocyte cells to detect the protective effect of crocin. Initially, to define the pure impact of aluminum phosphide poison and crocin on the heart cells, their effects on the biomarkers quantity in cell line were measured, separately, using the standard related kits. Later the effect of crocin with different concentration as a treatment on the oxidative stress biomarkers of the poisoned heart cells were monitored. Note that in pre-treatment case, the crocin was initially added to the cells before poisoning them. Data were analyzed using the analysis of variance method. KEY FINDINGS Results showed that crocin treatment reduced the aluminum phosphide (AlP) poisoning effect significantly. The treatment resulted in substantial deviation in the biomarkers of oxidative stress at the pre- and post-treatment phases for all groups. The oxidative markers values of the poisoned cells were recovered by crocin treatment. CONCLUSIONS Crocin is proposed as a potentially powerful antioxidant to treat the cardiotoxicity caused by aluminum phosphide poisoning.
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Affiliation(s)
- Mastoureh Naddafi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ali Eghbal
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Ghazi-Khansari
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Sattari
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yadollah Azarmi
- Pharmacology and Toxicology Department, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Hamade H, Sahin A, Sukhn C, El Tawil C, Rizk J, Kazzi Z, El Zahran T. Human Zinc Phosphide Exposure in Lebanon: A Case Report and Review of the Literature. Clin Pract Cases Emerg Med 2021; 5:50-57. [PMID: 33560952 PMCID: PMC7872605 DOI: 10.5811/cpcem.2020.10.47397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/05/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Toxicity from rodenticides such as metal phosphides is common worldwide, particularly in developing countries where consumers have access to unlabeled and uncontrolled insecticides and pesticides. Case Report We present the first documentation of a metal phosphide exposure in Lebanon. A middle-aged woman presented to the emergency department following the ingestion of an unknown rodenticide. Spectroscopy analysis of the sample brought by the patient was used and helped identify zinc phosphide. The patient developed mild gastrointestinal symptoms and was admitted to the intensive care unit for observation without further complications. Review We subsequently conducted a literature review to understand the diagnosis, pathophysiology, clinical presentation, and management of metal phosphide toxicity. Multiple searches were conducted on MEDLINE and PubMed, and articles related to the topics under discussion were included in the review. Metal phosphide is associated with significant morbidity and mortality involving all body systems. Patients presenting with metal phosphide intoxication need extensive workup including blood testing, electrocardiogram, and chest radiography. To date there is no antidote for metal phosphide toxicity, and management is mostly supportive. Many treatment modalities have been investigated to improve outcomes in patients presenting with metal phosphide toxicities. Conclusion Emergency physicians and toxicologists in developing countries need to consider zinc and aluminum phosphides on their differential when dealing with unlabeled rodenticide ingestion. Treatment is mostly supportive with close monitoring for sick patients. Further research is needed to better understand metal phosphide toxicity and to develop better treatment options.
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Affiliation(s)
- Hani Hamade
- American University of Beirut, Department of Emergency Medicine, Beirut, Lebanon
| | - Aynur Sahin
- Karadeniz Technical University, Trabzon, Turkey
| | - Carol Sukhn
- American University of Beirut, Department of Pathology and Laboratory Medicine, Beirut, Lebanon
| | - Chady El Tawil
- American University of Beirut, Department of Emergency Medicine, Beirut, Lebanon
| | - Jennifer Rizk
- American University of Beirut, Department of Emergency Medicine, Beirut, Lebanon
| | - Ziad Kazzi
- American University of Beirut, Department of Emergency Medicine, Beirut, Lebanon.,Emory University, Department of Emergency Medicine, Atlanta, Georgia, USA
| | - Tharwat El Zahran
- American University of Beirut, Department of Emergency Medicine, Beirut, Lebanon
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23
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Hosseini SF, Forouzesh M, Maleknia M, Valiyari S, Maniati M, Samimi A. The Molecular Mechanism of Aluminum Phosphide poisoning in Cardiovascular Disease: Pathophysiology and Diagnostic Approach. Cardiovasc Toxicol 2021; 20:454-461. [PMID: 32712815 DOI: 10.1007/s12012-020-09592-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Nowadays, poisoning with metal phosphides, especially aluminum phosphide (ALP), is one of the main health threats in human societies. Patients suffer from significant complications due to this type of poisoning, and the heart is one of the main organs targeted by ALP. Therefore, in this study, we discussed the effect of phosphine on cardiac function. This study is based on data obtained from PubMed, between 2002 and 2020. The key keywords included "Aluminum phosphide," "Oxidative Stress," "Mitochondria," "Cardiovascular disease," and "Treatment." The results showed that ALP produced reactive oxygen species (ROS) due to mitochondrial dysfunction. ROS production leads to red blood cell hemolysis, decreased ATP production, and induction of apoptosis in cardiomyocytes, which eventually results in cardiovascular disease. Since ALP has the most significant effect on cardiomyocytes, the use of appropriate treatment strategies to restore cell function can increase patients' survival.
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Affiliation(s)
| | - Mehdi Forouzesh
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mohsen Maleknia
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samira Valiyari
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Mahmood Maniati
- Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran
| | - Azin Samimi
- Legal Medicine Research Center, Legal Medicine Organization, Ahvaz, Iran. .,Department of Toxicology, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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24
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Mohammadi Pasand S, Ranjbar A, Kheiripour N, Ghasemi H, Rafieemehr H. Antioxidative Effects of Nanocurcumin and Curcumin Against Aluminum Phosphide-induced Serum Oxidative Stress. AVICENNA JOURNAL OF MEDICAL BIOCHEMISTRY 2020. [DOI: 10.34172/ajmb.2020.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objectives: Aluminum phosphide (AIP) is the commonly used pesticide in agriculture, which induces oxidative stress in almost all major body systems and organs. The aim of this study was to evaluate the efficacy of nanocurcumin and curcumin on serum oxidative stress level in subacute toxicity with AIP. Materials and Methods: In this study 36 male Wistar rats (220-250 g) were randomly divided into six groups. Control (C) receiving normal saline; group AIPreceiving AIP (2 mg/kg daily); group Cur receiving curcumin (100 mg/kg daily); group Nano-cur receiving nanocurcumin (100 mg/kg daily); group AIP+ Cur receiving AIP (2 mg/kg daily) and curcumin (100 mg/kg daily); and group AIP and Nano-cur receiving AIP (2 mg/kg daily) and nanocurcumin (100 mg/kg daily). Serum total antioxidant capacity (TAC), lipid peroxidation (LPO), total thiol groups (TTG), and catalase (CAT) activity were measured. Results: AIP administration led to a significant increase in LPO, and decreased the CAT activity, TAC, and TTG compared to the control group (P<0.05). Curcumin and nanocurcumin caused a significant decrease in the levels of LPO compared to the AIP-exposed groups (P<0.05). Moreover, in the nanocurcumin-treated groups, compared to a poisoned group, TAC and TTG increased significantly (P<0.01). There were no significant changes in CAT activity improvement. Conclusion: Nanocurcumin and curcumin improved the AIP-induced oxidative damage.
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Affiliation(s)
- Somayyeh Mohammadi Pasand
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nejat Kheiripour
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Hassan Ghasemi
- Department of Clinical Biochemistry, Abadan School of Medical Sciences, Abadan, Iran
| | - Hassan Rafieemehr
- Department of Medical Laboratory Sciences, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Suspected alimentary poisoning by aluminium phosphide in horses – a case report. ACTA VET BRNO 2020. [DOI: 10.2754/avb202089030231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In November 2018, a horse owner from the Czech Republic experienced the loss of two of his stallions in consequence of probable poisoning. The affected animals were kept in the stable only. The mares, which were grazing on pasture during the day, were not affected. All the animals were fed the same type of feed. The day before the animals became sick, between 15:00 to 19:00 h the stable was not secured against the entry of strangers. When the mares were brought back to the stable and all animals were closed and locked for the night, no signs of health issues were observed. In the following morning, the two stallions were found in lateral recumbency with seizure attacks. Despite symptomatic treatment (infusion with saline, flunixine meglumine, activated charcoal) and applications of myorelaxants, the symptoms persisted until the afternoon, and the owner agreed with euthanasia. Based on the clinical signs and pathological examination, poisoning by pesticides was suspected. The results of toxicological analyses revealed that carbofuran, metaldehyde, and strychnine were not responsible for the poisoning as they were not detected in the samples. The only positive finding was a high aluminium concentration in the stomach content, liver and kidney samples. Based on the observed symptoms and the high aluminium concentration, it was presumed that aluminium phosphide could be the source of poisoning. As there was no evidence of the possession of such product by the horse breeder and the stable stayed unsupervised for a few hours, intentional poisoning cannot be excluded.
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Oghabian Z, Ahmadi J, Pakravan S, Dabaghzadeh F, Heidari MR, Tajaddini S, Karami-Mohajeri S. Successful treatment of aluminium phosphide poisoning by dihydroxyacetone: A two-case report study. J Clin Pharm Ther 2020; 45:1194-1198. [PMID: 32526065 DOI: 10.1111/jcpt.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/26/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Aluminium phosphide (AlP) is an agricultural fumigant which produces phosphine gas in the presence of moisture. Phosphine inhibits oxidative phosphorylation and causes cell death by inhibiting cytochrome C oxidase. Clinical manifestations of AlP poisoning are refractory hypotension, tachycardia, low oxygen saturation and severe metabolic acidosis. CASE SUMMARY Two cases received dihydroxyacetone (DHA) in addition to routine management of AlP poisoning. Administration of DHA (7 gr in 50 mL sodium bicarbonate, gavage) 2 times at a 1-hour interval improved the clinical signs. WHAT IS NEW AND CONCLUSION This is the first case report to highlight the safe and successful treatment of AlP poisoning with DHA. However, more clinical studies are recommended to determine the precise mechanism of DHA action.
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Affiliation(s)
- Zohereh Oghabian
- Pharmaceutical Research Center, Institute of Neuropharmacology and Department of Clinical Toxicology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Jafar Ahmadi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrzad Pakravan
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Dabaghzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohmoud Reza Heidari
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrad Tajaddini
- Department of Clinical Toxicology, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayyeh Karami-Mohajeri
- Department of Pharmacology and Toxicology, Faculty of Pharmacy and Pharmaceutical Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Golaghaei A, Hassanian-Moghaddam H, Shadnia S, Zamani N, Amraei F. Potential prognostic roles of serum lactate and Creatine kinase levels in poisoned patients. BMC Emerg Med 2020; 20:32. [PMID: 32349695 PMCID: PMC7191820 DOI: 10.1186/s12873-020-00326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Examination of serum lactate level and its changes, as an indicator of tissue oxygenation, as well as level of creatine kinase (CK) inhibitors, as a factor of mortality which partially expresses heart, brain, and muscle damage, may be considered as tools to determine prognosis in critically ill patients. We aimed to evaluate these two factors as potential prognostic factors in critically poisoned patients admitted to our toxicology ICU. Method This is a cross-sectional descriptive-analytic study that was performed on poisoned patients referred to emergency department of Loghman Hakim Hospital. One-hundred critically poisoned patients who had been admitted to ICU were conveniently chosen using a random number table and included into the study after obtaining consent forms from their next of kin. Their serum lactate and CK levels were checked on admission. These levels were compared subsequently between survivors and non-survivors to seek for their potential prognostic role. Results In a total of 100 patients enrolled, 61 were male. Serum level of lactate (with a cut off of 26 mg/dL) and serum CK with a cutoff point of 169 U/L could have prognosticated death with sensitivity and specificity of 78 and 77% (for lactate) and 74 and 62% (for serum CK), respectively. Conclusions In poisoned patients, serum lactate and CK can be used as possible prognostic factors because they rapidly increase in the serum and are easily detectable.
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Affiliation(s)
| | - Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasim Zamani
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Toxicological Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Pannu AK, Bhalla A, Gantala J, Sharma N, Kumar S, Dhibar DP. Glucose-insulin-potassium infusion for the treatment of acute aluminum phosphide poisoning: an open-label pilot study. Clin Toxicol (Phila) 2020; 58:1004-1009. [DOI: 10.1080/15563650.2020.1719131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A. K. Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A. Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J. Gantala
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - N. Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S. Kumar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D. P. Dhibar
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Güvenç M, Cellat M, Gökçek İ, Arkalı G, Uyar A, Tekeli İO, Yavaş İ. Tyrosol prevents AlCl 3 induced male reproductive damage by suppressing apoptosis and activating the Nrf-2/HO-1 pathway. Andrologia 2019; 52:e13499. [PMID: 31828839 DOI: 10.1111/and.13499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 01/08/2023] Open
Abstract
Aluminium is a ubiquitous element that occurs naturally in the soil making human exposure to it is unavoidable. Tyrosol is present in olive oil and is known to have antioxidant effects. Therefore, the present study explores the toxic effects of aluminium chloride (AlCl3 ) and evaluates the possible protection by tyrosol in male rats. Testicular injury was induced by the administration of AlCl3 (34 mg kg-1 day-1 ). Rats were treated with either tyrosol (20 mg kg-1 day-1 ) or AlCl3 (34 mg kg-1 day-1 ). The experiment lasted for 10 weeks. Biochemical, histopathological and protein expression profiles were determined to decipher the role of tyrosol in protecting the cellular damage. Further, histomorphometric analyses of testes showed deranged architecture along with other noted abnormalities. AlCl3 group rats' testes showed decreased GSH levels, CAT activities, Nrf-2, HO-1, bcl-2 expressions and sperm motility whereas increased caspase-3 expressions, MDA levels, abnormal and dead/live sperm ratio. However, tyrosol treatment attenuated these changes. The present results demonstrate the beneficial role of tyrosol treatment in AlCl3 induced testicular toxicity alterations of rat.
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Affiliation(s)
- Mehmet Güvenç
- Department of Physiology, Faculty of Veterinary Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Mustafa Cellat
- Department of Physiology, Faculty of Veterinary Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İshak Gökçek
- Department of Physiology, Faculty of Veterinary Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Gözde Arkalı
- Department of Physiology, Faculty of Veterinary Science, Firat University, Elazig, Turkey
| | - Ahmet Uyar
- Department of Pathology, Faculty of Veterinary Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İbrahim Ozan Tekeli
- Department of Pharmocology and Toxicology, Faculty of Veterinary Science, Hatay Mustafa Kemal University, Hatay, Turkey
| | - İlker Yavaş
- Department of Reproduction and Artificial Insemination, Faculty of Veterinary Science, Hatay Mustafa Kemal University, Hatay, Turkey
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Sheta AA, El-Banna AS, Elmeguid RA, Mohamed HE, Gad NH. A study of the predictive factors of mortality in acute poisoning with aluminum phosphide with special reference to echocardiography and SOFA score. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:33135-33145. [PMID: 31520378 DOI: 10.1007/s11356-019-06457-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
Aluminum phosphide (AlP) is considered now one of the most common causes of poisoning among agricultural pesticides. Poisoning with AlP is extremely toxic to humans with high mortality rate. The aim of this work was to evaluate the prognostic factors and outcome of acute aluminum phosphide poisoning in Alexandria Main University Hospital during a period of 6 months from 1 November 2017 until the end of April 2018, highlighting the role of SOFA score and echocardiography in predicting the mortality. The prospective study was conducted on all patients admitted with acute AlP poisoning to Alexandria Main University Hospital for those 6 months. Patients' data were collected in a special sheet and included biosocial data, medical history, poisoning history, complete medical examination, investigations, duration of hospital stay, and the outcome. All patients were assessed according to SOFA score on admission. Thirty patients were admitted during the period of the current study. Females outnumbered males in all age groups with a sex ratio of 2.75:1. The mean age of patients was 22.77 ± 12.79 years. 96.6% of patients came from rural areas. 93.3% of the cases were exposed to poisoning at home, where suicidal poisoning accounted for (86.7%) of cases. 43.3% of patients died (n = 13), and the median value of SOFA score among non-survivors was 10, versus 1 among survivors. The median value of ejection fraction among non-survivors (25%) was half its value in survivors (50%). Although there were many predictors of severity of AlP poisoning, SOFA score was the most predictive factor of mortality detected by multivariate analysis.
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Affiliation(s)
- Abeer A Sheta
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Asmaa S El-Banna
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rania Abd Elmeguid
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany E Mohamed
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nehad H Gad
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Zhang DD, Liu JM, Sun SM, Liu C, Fang GZ, Wang S. Construction of Persistent Luminescence-Plastic Antibody Hybrid Nanoprobe for In Vivo Recognition and Clearance of Pesticide Using Background-Free Nanobioimaging. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2019; 67:6874-6883. [PMID: 31144502 DOI: 10.1021/acs.jafc.9b02712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We prepared a specific adsorptive nanocarrier for pesticide due to its challenge to cleanup and low detoxification in the treatment after intake, whether intentional or by mistake. We modified the plastic antibody (molecularly imprinted polymer (MIP)) on the surface of persistent luminescence nanoparticle (La3Ga5GeO14: Cr3+, Zn2+, LGGO) as the specific adsorptive nanocarrier for toxic molecules and realized the nanocarrier was widely distributed for absorbing pesticide and real-time in vivo bioimaging. We used LGGO as the core and trichlorphon as the template to prepare the plastic antibody nanocarrier. After in vivo bioimaging and biodistribution of mice, LGGO@MIP could be distributed evenly in the gastrointestinal tract, circulated in the blood for a long time, and finally excreted to achieve the adsorption and removal of pesticide in the body. The LGGO@MIP nanocarrier prepared in this study opens a new way for the treatment of poisoning.
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Affiliation(s)
- Dong-Dong Zhang
- State Key Laboratory of Food Nutrition and Safety , Tianjin University of Science & Technology , Tianjin 300457 , P. R. China
- Collaborative Innovation Center of Henan Grain Crops, Henan Collaborative Innovation Center of Grain Storage and Security , Henan University of Technology , Zhengzhou 450001 , P. R. China
| | - Jing-Min Liu
- Tianjin Key Laboratory of Food Science and Health, School of Medicine , Nankai University , Tianjin 300071 , P. R. China
| | - Shi-Ming Sun
- State Key Laboratory of Food Nutrition and Safety , Tianjin University of Science & Technology , Tianjin 300457 , P. R. China
| | - Chang Liu
- State Key Laboratory of Food Nutrition and Safety , Tianjin University of Science & Technology , Tianjin 300457 , P. R. China
| | - Guo-Zhen Fang
- State Key Laboratory of Food Nutrition and Safety , Tianjin University of Science & Technology , Tianjin 300457 , P. R. China
| | - Shuo Wang
- State Key Laboratory of Food Nutrition and Safety , Tianjin University of Science & Technology , Tianjin 300457 , P. R. China
- Tianjin Key Laboratory of Food Science and Health, School of Medicine , Nankai University , Tianjin 300071 , P. R. China
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Garrett KK, Frawley KL, Totoni SC, Bae Y, Peterson J, Pearce LL. Antidotal Action of Some Gold(I) Complexes toward Phosphine Toxicity. Chem Res Toxicol 2019; 32:1310-1316. [PMID: 31070361 PMCID: PMC7723013 DOI: 10.1021/acs.chemrestox.9b00095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Phosphine (PH3) poisoning continues to be a serious problem worldwide, for which there is no antidote currently available. An invertebrate model for examining potential toxicants and their putative antidotes has been used to determine if a strategy of using Au(I) complexes as phosphine-scavenging compounds may be antidotally beneficial. When Galleria mellonella larvae (or wax worms) were subjected to phosphine exposures of 4300 (±700) ppm·min over a 20 min time span, they became immobile (paralyzed) for ∼35 min. The administration of Au(I) complexes auro-sodium bisthiosulfate (AuTS), aurothioglucose (AuTG), and sodium aurothiomalate (AuTM) 5 min prior to phosphine exposure resulted in a drastic reduction in the recovery time (0-4 min). When the putative antidotes were given 10 min after the phosphine exposure, all the antidotes were therapeutic, resulting in mean recovery times of 14, 17, and 19 min for AuTS, AuTG, and AuTM, respectively. Since AuTS proved to be the best therapeutic agent in the G. mellonella model, it was subsequently tested in mice using a behavioral assessment (pole-climbing test). Mice given AuTS (50 mg/kg) 5 min prior to a 3200 (±500) ppm·min phosphine exposure exhibited behavior comparable to mice not exposed to phosphine. However, when mice were given a therapeutic dose of AuTS (50 mg/kg) 1 min after a similar phosphine exposure, only a very modest improvement in performance was observed.
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Affiliation(s)
- Kimberly K. Garrett
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, Pittsburgh, PA 15219
| | - Kristin L. Frawley
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, Pittsburgh, PA 15219
| | - Samantha Carpenter Totoni
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, Pittsburgh, PA 15219
| | - Yookyung Bae
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, Pittsburgh, PA 15219
| | - Jim Peterson
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, Pittsburgh, PA 15219
| | - Linda L. Pearce
- Department of Environmental and Occupational Health, Graduate School of Public Health, The University of Pittsburgh, Pittsburgh, PA 15219
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A novel fluorescence based assay for the detection of organophosphorus pesticide exposed cholinesterase activity using 1-naphthyl acetate. Biochimie 2019; 160:100-112. [DOI: 10.1016/j.biochi.2019.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/22/2019] [Indexed: 01/18/2023]
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Maleki A, Hosseini MJ, Rahimi N, Abdollahi A, Akbarfakhrabadi A, Javadian N, Amiri S, Behnoush B, Dehpour AR. Adjuvant potential of selegiline in treating acute toxicity of aluminium phosphide in rats. Basic Clin Pharmacol Toxicol 2019; 125:62-74. [DOI: 10.1111/bcpt.13207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Adeleh Maleki
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology, Faculty of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Mir-Jamal Hosseini
- Department of Pharmacology and Toxicology, School of Pharmacy; Zanjan University of Medical Sciences; Zanjan Iran
| | - Nastaran Rahimi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology, Faculty of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Alireza Abdollahi
- Department of Pathology; Imam Hospital complex, Tehran University of Medical Sciences; Tehran Iran
| | - Amir Akbarfakhrabadi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology, Faculty of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Nina Javadian
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology, Faculty of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Shayan Amiri
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology, Faculty of Medicine; Tehran University of Medical Sciences; Tehran Iran
- Regenerative Medicine Program, Department of Biochemistry and Medical Genetics, Rady College of Medicine, Max Rady Faculty of Health Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - Behnam Behnoush
- Department of Forensic Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology, Faculty of Medicine; Tehran University of Medical Sciences; Tehran Iran
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Dihydroxyacetone as a definitive treatment for aluminium phosphide poisoning in rats. Arh Hig Rada Toksikol 2018; 69:169-177. [PMID: 29990298 DOI: 10.2478/aiht-2018-69-3106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/01/2018] [Indexed: 11/21/2022] Open
Abstract
Aluminium phosphide (AlP), a very toxic pesticide also known as the rice tablet, releases phosphine gas upon contact with water, moisture, or gastric acid. Its mortality rate in humans is 70-100 % due to cardiogenic shock and refractory hypotension. Dihydroxyacetone (DHA) is a simple ketonic carbohydrate, mainly used for sunless skin tanning. It also plays a beneficial role in the treatment of hypotension and cardiogenic shock by restoring blood volume and cellular respiration. The aim of this study was to investigate the its effect on the haemodynamics and electrocardiogram (ECG) in male rats poisoned with AlP. The animals were divided into the following groups: control (received 1 mL corn oil, orally), AlP (received 15 mg kg-1 AlP solved in corn oil, orally), AlP plus DHA (treated with 50 mg kg-1 of DHA 30 min after receiving AlP), and AlP plus N-acetyl cysteine (NAC) (treated with 200 mg kg-1 of NAC 30 min after receiving AlP). The animals were then anaesthetised and ECG, blood pressure, and heart rate were recorded for 120 min. Treatment with AlP alone and in combination with NAC was associated with progressive hypotension, tachycardia, and ECG disturbances in rats, resulting in 100 % mortality 3 h after poisoning. However, DHA achieved 100 % survival in the poisoned rats and prevented AlP-induced ECG and haemodynamic abnormalities. The main mechanism of DHA in the treatment of AlP poisoning is unclear, but the findings suggest the promising therapeutic potential of DHA against AlP poisoning.
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Karimani A, Mohammadpour AH, Zirak MR, Rezaee R, Megarbane B, Tsatsakis A, Karimi G. Antidotes for aluminum phosphide poisoning - An update. Toxicol Rep 2018; 5:1053-1059. [PMID: 30406022 PMCID: PMC6214862 DOI: 10.1016/j.toxrep.2018.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023] Open
Abstract
Aluminum phosphide (AlP), an inexpensive solid fumigant, is frequently used for grain conservation despite its alleged high toxicity. Increased utilization of AlP for agricultural and non-agricultural purposes during the last four decades has resulted in increment of AlP-attributed poisoning numbers. Moreover, due to its limitless accessibility in developing countries, AlP has been increasingly used for suicide. Moisture-exposed AlP undergoes a chemical reaction producing phosphine gas, which in turn inhibits cytochrome oxidase and impedes cellular oxygen consumption. Lethality remains elevated reaching rates of >50% and no effective antidote is available. Nevertheless, experimental and clinical studies suggested that magnesium sulfate, melatonin, N-acetylcysteine, glutathione, sodium selenite, vitamin C and E, triiodothyronine, liothyronine, vasopressin, milrinone, Laurus nobilis L., 6-aminonicotinamide, boric acid, acetyl-L-carnitine and coconut oil, may serve as antidotes by reducing the deleterious oxidative properties of AlP. This article reviews the afore-mentioned chemicals suggested to specifically treat AlP poisoning and discusses their protective mechanisms and main outcomes.
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Affiliation(s)
- Asieh Karimani
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Zirak
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France
| | - Aristidis Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Gholamreza Karimi
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran
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Yan H, Chen H, Li Z, Shen M, Zhuo X, Wu H, Xiang P. Phosphine Analysis in Postmortem Specimens Following Inhalation of Phosphine: Fatal Aluminum Phosphide Poisoning in Children. J Anal Toxicol 2018; 42:330-336. [PMID: 29378027 DOI: 10.1093/jat/bky005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 11/13/2022] Open
Abstract
Phosphine is an insecticide for the fumigation of grains, animal feed, and leaf-stored tobacco, and it was used as a rodenticide in bulk grain stores. Phosphine poisoning may occur after accidental inhalation of phosphine, sometimes leading to death. Analysis of phosphine and its metabolites in postmortem specimens from seven fatal cases was conducted in this study, as well as postmortem specimens collected from rabbits exposed to phosphine. The total phosphine in postmortem specimens was analyzed by headspace gas chromatography coupled with mass spectrometry. Diagnosis of aluminum phosphide poisoning was made after postmortem toxicological analysis and confirmed by police investigation. The deaths of the children occurred after inhalation of phosphine generated from aluminum phosphide contacting moisture in the air in all seven fatal cases. The concentration of total phosphine in the biological fluids and tissues of victims ranged from 0.2 to 4.7 μg/mL (μg/g). Animal experiments demonstrated that the phosphine generated from aluminum phosphide could rapidly cause death. The toxicological analysis of postmortem specimens provides useful information in diagnosis of aluminum phosphide poisoning in forensic science. As an important fumigation pesticide, aluminum phosphide deserves special attention, especially since there is no specific antidote and there is a high fatality rate.
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Affiliation(s)
- Hui Yan
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Hang Chen
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Zhengdong Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Min Shen
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Xianyi Zhuo
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Hejian Wu
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
| | - Ping Xiang
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Guangfu Xi Road 1347, Shanghai 200063, China
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Whole blood exchange transfusion as a promising treatment of aluminium phosphide poisoning. Arh Hig Rada Toksikol 2018; 69:275-277. [PMID: 30285939 DOI: 10.2478/aiht-2018-69-3129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/01/2018] [Indexed: 11/20/2022] Open
Abstract
A 37-year-old male was referred to us about one hour after deliberate ingestion of two 3-gram aluminium phosphide (ALP) tablets. Three hours after admission, his blood pressure dropped to 85/55 mmHg, his heart rate increased to 120 bpm, O2 saturation dropped to 82 %, and the electrocardiogram showed junctional rhythm. We started whole blood exchange, and gross haematuria and jaundice ensued. However, his blood pressure increased, arrhythmia resolved itself, and he was extubated two days after the transfusion was completed. He was sent home seven days after admission completely symptom-free. We believe this treatment may be successfully applied in ALP-poisoned patients.
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Farzaneh E, Ghobadi H, Akbarifard M, Nakhaee S, Amirabadizadeh A, Akhavanakbari G, Keyler DE, Mehrpour O. Prognostic Factors in Acute Aluminium Phosphide Poisoning: A Risk-Prediction Nomogram Approach. Basic Clin Pharmacol Toxicol 2018. [PMID: 29527823 DOI: 10.1111/bcpt.13005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aluminium phosphide (AlP) is a toxic agent associated with a high mortality rate following acute exposure from various routes. The aim of this study was to determine the clinical and laboratory findings useful for predicting the medical outcome of AlP-poisoned patients using established scoring systems. This is a prospective study of AlP-poisoned patients from 2010 to 2015 in Ardabil, Iran. All patients that presented with a confirmed diagnosis of acute AlP poisoning in the study interval were included in the study. Clinical and laboratory data, using Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score II (SAPS II) scoring systems, were compared for their predictive value in determining differences between survived and non-survived patients. Univariate analysis (Mann-Whitney or t-test), multiple logistic regression analysis, receiver operating characteristic (ROC) curve analysis and the Pearson correlation test were performed using STATA/SE 13.0 and the Nomolog Software. A total of 68 AlP-poisoned patients with confirmed acute AlP poisoning were included for evaluation. Of these, 36 were non-survived. Multiple logistic regression analysis was performed using parameters and values derived from patient clinical and laboratory data, and revealed that four factors were significant for predicting mortality: Glasgow coma score (GCS); systolic blood pressure (SBP); urinary output (UOP); and serum HCO3 . A four-variable, risk-prediction nomogram was developed for identifying high-risk patients and predicting the risk of mortality. Study results showed that SBP of <92.5 mmHg (p = 0.006); HCO3- < 12.9 mEq/L (p = 0.01), UOP < 1725 mL/day (p = 0.04); and GCS < 14.5 (p = 0.003) were significant predictors of AlP mortality. Scoring systems analysis showed SAPS II score >24.5, APACHE II score >8.5 and SOFA score >7.5 were predictive of non-survival patients. The results of our study showed that SBP, GCS, UOP and serum HCO3 levels are the best prognostic factors for predicting mortality in AlP-poisoned patients. According to the area under the ROC curve of the APACHE II score, when compared with SOFA and SAPS II scores, the APACHE II score can more effectively discriminate between non-survivors and survived patients.
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Affiliation(s)
- Esmaeil Farzaneh
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Ghobadi
- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mahdieh Akbarifard
- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Samaneh Nakhaee
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Alireza Amirabadizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | | | - Daniel E Keyler
- Department of Experimental & Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
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Zamani N, Hassanian-Moghaddam H. RE: Comment on Asghari et al. 2017: On the mechanisms of melatonin in protection of aluminum phosphide cardiotoxicity. Arch Toxicol 2017; 92:1905-1906. [DOI: 10.1007/s00204-017-2136-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
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Sanaei-Zadeh H, Marashi SM. Gastric decontamination in aluminium phosphide poisoning: a case against the use of water-based solutions. Arh Hig Rada Toksikol 2017; 67:364-365. [PMID: 28033095 DOI: 10.1515/aiht-2016-67-2900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mirakbari SM. Letter to the Editor. A review of aluminium phosphide poisoning and a flowchart to treat it: recommendation for a revision. Arh Hig Rada Toksikol 2017; 68:74. [DOI: 10.1515/aiht-2017-68-2934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Seyed Mostafa Mirakbari
- Qazvin University of Medical Sciences; Bu Ali Hospital, Department of Clinical Toxicology, Qazvin, Iran (Islamic Republic of)
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Hassanian-Moghaddam H, Zamani N. Re: Thoughts on the Current Management of Acute Aluminum Phosphide Toxicity and Proposals for Therapy: An Evidence-based Review. Indian J Crit Care Med 2017; 21:61-62. [PMID: 28197057 PMCID: PMC5278597 DOI: 10.4103/0972-5229.198332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hossein Hassanian-Moghaddam
- Toxicological Research Center, Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Excellence Center of Clinical Toxicology, Iranian Ministry of Health and Medical Education, Tehran, Iran
| | - Nasim Zamani
- Toxicological Research Center, Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Excellence Center of Clinical Toxicology, Iranian Ministry of Health and Medical Education, Tehran, Iran
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